Immigrants fill close to 3 in 10 direct care jobs: the nursing assistants, home health aides and personal care aides who help older Americans bathe, dress and get through the day. The Paraprofessional Healthcare Institute (PHI), a research group that studies this workforce, put their share at 28% in 2022, up from 21% in 2011.
The need is growing. PHI projects nearly 775,000 new direct care jobs within the next decade as the population ages, and that figure counts only growth, not the far larger churn of workers who leave the field and must be replaced.
Federal policy has narrowed several routes those workers use. The Trump administration suspended nearly all refugee programs in January 2025 and terminated Temporary Protected Status (TPS) for people from 13 countries, Wisconsin Watch reported. About 53,000 TPS holders worked in health care in 2024, the outlet said.
On June 25, 2026, the Supreme Court ruled 6-3 that the Department of Homeland Security has broad discretion to end TPS with little judicial oversight, according to ABC News. The decision allows the administration to cancel protections for Haitians and Syrians.
NPR reported in April 2026 that the case covered more than 300,000 Haitians and about 6,000 Syrians.
Katie Smith Sloan, CEO of LeadingAge, said nearly every pipeline for bringing in foreign-born workers has been cut off or severely limited, as Wisconsin Watch reported.
What it could do to prices
So far the price effect is a forecast. CNBC reported that experts say immigration policy changes could worsen the care worker shortage and raise costs for families. The 2025 CareScout Cost of Care Survey found cost growth slowing in most settings, and its CEO said growth flattened in 2025 after multiple years of elevated increases.
The baseline is steep. The survey’s national median for a non-medical in-home caregiver is $35 an hour, or $80,080 a year at 44 hours a week, up 3% from the prior year. Assisted living has a median of $6,200 a month, or $74,400 a year, up 5%. A private room in a nursing home has a median of $355 a day, or $129,575 a year, up 1%.
The survey predates the June 2026 ruling, so these figures describe the starting point, not the effect.
Medicare will not cover it
Medicare does not cover custodial care, the day-to-day help with things like bathing and dressing, which can leave families facing six-figure bills that eat into retirement savings. About 7 in 10 people turning 65 will need some form of long-term care, according to government data.
Long-term care insurance helps fill that gap, covering services like home care, assisted living and help with daily tasks. Rates are typically lowest if you buy in your 50s or early 60s, couples often qualify for discounts, and premiums may even be tax-deductible. A little planning now can spare your family a difficult financial situation later. See a list of the best long-term care insurance companies in two minutes.
Families that plan to rely on Medicaid face rules of their own. Paying a relative for care without a written contract can cost a parent Medicaid eligibility, and deeding the house to the children can trigger a penalty and a tax bill.
The Money Talks News financial advisor page can help you find an advisor to price out a care plan.
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